Web Exclusive: A View From Across the Pond

For another look at how dentists and their laboratory technicians can best work together synergistically toward the shared goal of enhanced patient care, Inside Dentistry was privileged to speak with former ceramist and laboratory technician, Ralf Suckert, owner of Teamwork Media Publishing Group. Mr. Suckert shares with readers where he sees the role of laboratory technicians in the advent of new technologies such as CAD/CAM, as well as what he believes dentists in the United States should be looking for in a dental laboratory.

In Europe, a dental laboratory technician earns a four-year degree prior to entering the laboratory. Not surprisingly, they can offer an interesting, perhaps different perspective regarding what can facilitate effective collaboration between dentists and laboratories. They also may see key differences between laboratories in the United States and those in Europe .

For another look at how dentists and their laboratory technicians can best work together synergistically toward the shared goal of enhanced patient care, Inside Dentistry was privileged to speak with former ceramist and laboratory technician, Ralf Suckert. Admittedly, his years as a dental ceramist were 20 years ago, but he still applies and shares his knowledge of the craft through his latest venture as an editor in the dental industry.

After studying journalism, graphic arts, and postgraduate study in publishing management, he cultivated a reputation for authoring books and articles with world-renowned technicians and dentists. As an analyst, teacher, lateral thinker, and dental journalist, Mr. Suckert is astutely aware of both sides of the coin, which is why dentists and dental technicians trust his judgment in a consulting capacity.

Today, Mr. Suckert owns Teamwork Media Publishing Group, the third largest publishing house in Germany, with partners in 15 countries. During this interview, Mr. Suckert shares with readers where he sees the role of laboratory technicians in the advent of new technologies such as CAD/CAM, as well as what he believes dentists in the United States should be looking for in a dental laboratory.

Inside Dentistry: Mr. Suckert, can you elaborate on the education and training which dental technicians in Europe receive and how, as a result, they are able to contribute to effective collaboration between dentists and laboratories?

Mr. Suckert: Traditionally, German universities have been rather less preoccupied with preparing students for an actual profession or vocation, least of all the more tangible ones. Dental technician training generally follows the so-called "dual education" or apprentice/journeyman/master craftsman model. In this system, theoretical subjects generally are taught at vocational schools by specially trained vocational teachers. Practical skills are acquired concurrently in dental laboratories under the instruction of a master dental technician. In a given week, theoretical or practical training may alternate, or the theoretical aspects can be taught in solid blocks of time over several weeks. During the three-and-a half-year apprenticeship, the apprentice acquires solid theoretical knowledge and practical skills in all fields of dental technology. He or she then will submit to the final examination and graduate as Geselle (journeyman), which is vaguely comparable to being a Certified Dental Technician (CDT).

Having worked as Geselle for three years, the dental technician may enroll in a Master Dental Technician (Meister; in English, often abbreviated as MDT) course, which is conducted at state or private Master Dental Technician schools. The MDT exam is the highest and most important qualification exam. Courses are available on a full-time or part-time basis. Passing the MDT exam is one of the prerequisites for starting a commercial laboratory or filling a leadership position in an existing commercial laboratory.

Only during the past few years has dental technology begun to be taught as an academic subject at selected German technical colleges. There are many good reasons for embarking on a university course of dental technology. For example, many CDTs and even MDTs would like to expand their knowledge and expertise because they have or have developed an interest in technical sciences or research. Other students are planning a career in the dental materials field. Most college graduates of dental technology currently find employment in the dental industry. One of my editors, too, is a university graduate of dental technology.

But regardless of the academic structures in which they are taught, knowledge and skill form the foundation for any successful collaboration between dentists and dental technicians, especially given the rapid pace of change in our field. More and more, dentists are dependent on the support of excellently trained specialists. Smart dentists work exclusively with well-trained technicians, and wise dentists always treat them as equals. Moreover, savvy dentists are willing to pay what the dental technician's service is worth. A somewhat stale but very true adage says that if you pay peanuts, you will get monkeys. Dentists not willing to pay a fair price should not be surprised if the monkeys are the only ones left willing to work for them. Part of the motivation for any work is appropriate pay.

Inside Dentistry: What do you see as the key differences between dental laboratories in the United States and those in Europe?

Mr. Suckert: To me, the key difference is the level of training of the staff. As far as I know, many dental labs in the United States work with semi-skilled (meaning, specifically or singularly skilled) labor. These employees will usually only be responsible for part of a given fabrication process. For example, they would be doing models only, wax-ups only, veneers only, etc. If you work like this, you will never get a comprehensive view of the therapeutic objective of the restoration as a whole. Admittedly, however, the work efficiency in these labs is very high. In many German labs, by contrast, the same technician will work on the same restoration from beginning to end, from impression to final delivery. This benefits the quality of the restoration, but it also drives up the cost. This is where the balancing act between professionalism and commercialism becomes very obvious. Personally, I believe that you can have it both ways: you can afford professional standards and still be economically successful. The importance of professional values is demonstrated by the current crisis. Not only will the banks take a close look at their professional practices, but also other professions, including ours. Are we really still working for the health of the patient, or are we just in it for the money? First and foremost, dentistry and dental technology should benefit the patient. To me, these two are inextricably linked.

Inside Dentistry: Where do you see the role of the laboratory technician going with the advent of new technologies like CAD/CAM?

Mr. Suckert: At first glance, digital technologies would seem to make many tasks easier. A closer look reveals that they are turning the field of dental technology into something much more complex. Many technicians had feared that the digital revolution might ultimately cost them their jobs. However, However, this is not going to be the case. Rather, dentists of the future will need to treat dental labs as their very own digital competence centers. They will be sending data to the laboratory, such as cone beam computed tomography ( CBCT) data of temporomandibular joint (TMJ) function, CBCT data of the bony implant bed, intraoral preparation scans, and the like. These data require analysis (ie, dental technicians will have to learn how to address the data and be aware of the treatment objectives). Dental technicians will have to support dentists in choosing the right implant positions from the restorative point of view, and they must be able to produce a digital set-up for a backward-planning scenario and for treatment-critical provisional restorations. They will have to interpret functional diagnostic data in the articulator; perform esthetic imaging directly on patients; match structural, functional, and esthetic requirements; and even assist in the choice of a suitable material. This certainly does not sound like the job description of a semi-skilled assistant, or like something that the dentist could do on the side. The dental laboratory technician of the future is a highly qualified specialist with expertise in the medical, technical, and materials field; in short, an engineer and designer in dental technology, and presumably a college graduate (bachelor's degree). This is the future of dental technology as a craft as I see it.

Inside Dentistry: What should dentists in the United States be looking for in a dental laboratory?

Mr. Suckert: The most expensive line item on the balance sheet of a dental practice is and will continue to be the dentist's time. Dental laboratories should therefore assist dentists in making the best possible use of their time. If a laboratory delivers restorations that simply work (with regard to function, phonetics, esthetics, structure, fit), this is a sign that you are dealing with experts. The need for remakes and corrections on a regular basis can be catastrophic. Success-driven dentists will look for specialists who stay up-to-date in their field (by reading professional journals and attending courses and conferences), whose level of professional sophistication matches that of the dentist, and who are able to make original contributions toward a restorative solution. If that is the case, the dentist will be in good hands.